| NPI | 1952425308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA ma00021742) |
| 225700000X Massage Therapist | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2026-01-29 |